Practice AreaAdvance Care Planning

The Advanced HealthCare Directive and the “POLST”

Advance Care Planning generally refers to the decision-making regarding healthcare issues as we age. It involves making important decisions about your wishes for medical intervention and end-of-life, including the decision to nominate a health care agent to implement your wishes if you are unable to do so.

The process begins with a discussion between you and your loved ones. To help you begin the process, there is an excellent “Conversation Guide” prepared by the California Coalition for Compassionate Care and available for free download at www.finalchoices.org, or by calling 916-552-7573. The guide is very short and well worth reading. It is not necessary that the entire conversation be conducted in one sitting. Instead, it can be a gradual process that is raised periodically, perhaps triggered by a news event involving the death or illness of a celebrity, a trip to the doctor, or the circumstance of a close friend. It should also be a discussion that is renewed periodically, just in case your wishes change over time. One of the best ways to ensure that your wishes are honored is for you to communicate them to your loved ones and your own physicians.

In terms of formal documents, we also suggest that your parents sign anAdvance Healthcare Directive, which expresses your end-of-life wishes and appoints a health care agent to implement them if you are unable to do so. You may either sign a preprinted form, such as the one prepared by the California Medical Association and available for purchase by calling 1-800-882-1262 (www.cmanet.org), or by engaging your estate planning or elder law attorney to prepare a customized document for you. Note: While this directive is a very valuable and important document, studies do show that end-of-life decisions are, unfortunately, not honored as much as most people think. Sometimes the signed directive is not available at the time of need, or is not clear, or the designated agent is just unwilling to give up the hope that further treatment may restore their loved one to health. We therefore recommend that you also take the following further step:

For persons faced with a serious or potentially terminal illness, they should initiate a discussion with their physician with the idea of jointly signing a document known as “Physician Orders for Life-Sustaining Treatment (“POLST”). This is an innovative medical form recently enacted in California, which allows patients to specify what kind of care they wish at the end of their life. The most important feature, and the one that distinguishes this form from the Advance Healthcare Directive, is that the form is signed by the patient’s doctor and becomes an actual physician’s order. As such, it carry special weight because it then must be honored by all medical personnel involved in treatment. Your physician, then, rather than any designated agent, would have responsibility for implementing your wishes. By doing this, you may relieve your agent of the responsibility of making the final decisions.

The POLST form is designed to become a permanent part of your medical records and to travel with you and your medical chart as you move from one treatment facility to another. It is printed on bright pink paper so that it is easily identifiable in your medical chart. At least one study has shown that patients who had properly executed POLST forms had much less unwanted hospitalization and medical interventions. For more information and a POLST form, you may visit www.capolst.org., or you may also call the Coalition for Compassionate Care of California at 916-489-2222.

Remember, that opening this conversation is an act of love for all parties